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Yellow fever vaccine for patients with HIV infection

  1. Hilary Barte,
  2. Tara H Horvath,
  3. George W Rutherford*

Editorial Group: Cochrane HIV/AIDS Group

Published Online: 23 JAN 2014

Assessed as up-to-date: 7 JAN 2014

DOI: 10.1002/14651858.CD010929.pub2


How to Cite

Barte H, Horvath TH, Rutherford GW. Yellow fever vaccine for patients with HIV infection. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD010929. DOI: 10.1002/14651858.CD010929.pub2.

Author Information

  1. University of California, San Francisco, Global Health Sciences, San Francisco, California, USA

*George W Rutherford, Global Health Sciences, University of California, San Francisco, 50 Beale Street, Suite 1200, San Francisco, California, 94122, USA. GRutherford@psg.ucsf.edu.

Publication History

  1. Publication Status: New
  2. Published Online: 23 JAN 2014

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Characteristics of included studies [ordered by study ID]
Pacanowski 2012

MethodsA prospective cohort study analysing a cohort of 364 patients diagnosed with HIV infection who were given YF vaccination.


Participants364 patients diagnosed with HIV infection who were given YF vaccination - 124 patients were immunised before HIV diagnosis and 204 patients were immunised after HIV diagnosis. All patients attended Saint-Antoine Hospital in Paris, France.


InterventionsArm 1: Received YF vaccination before diagnosis of HIV infection.

Arm 2: Received yellow fever vaccination after diagnosis of HIV infection.


OutcomesYF antibody response (immunogenicity and duration)


NotesOf note: At time of YF immunisation, 14 patients vaccinated after HIV diagnosis had CD4 cell count <200 cell/mm3. Among these, 6/14 had HIV RNA load >400 copies/mL. Of the 14, 4 received primary vaccination while 7 received booster injection (data were missing for the remaining three patients). After a mean delay of 4.6 years after immunisation, these 11 patients exhibited a NT>1:10. They had no serious adverse events.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskObservational study

Allocation concealment (selection bias)High riskObservational study

Blinding of participants and personnel (performance bias)
All outcomes
High riskObservational study

Blinding of outcome assessment (detection bias)
All outcomes
High riskObservational study

Incomplete outcome data (attrition bias)
All outcomes
Low riskSimilar reasons for missing data across groups

Selective reporting (reporting bias)Unclear riskInsufficient information to permit judgment of 'Yes' or 'No'.

Other biasUnclear riskNone detected

Sibailly 1997

MethodsObservational cohort study (embedded in a PMTCT cohort study)


Participants18 HIV-infected children and 57 HIV-uninfected children in Abidjan, Côte d'Ivoire


InterventionsBetween June 1991 and June 1993 all children received a single 0.5 ml dose of 17D YF vaccine and measles vaccine at a mean of 10 months of age (range 7 months to 14 months). Children were followed for a median 29 months.


OutcomesAdequate YF antibody response.


NotesPre-ART era


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskObservational study

Allocation concealment (selection bias)High riskObservational study

Blinding of participants and personnel (performance bias)
All outcomes
High riskObservational study

Blinding of outcome assessment (detection bias)
All outcomes
High riskObservational study

Incomplete outcome data (attrition bias)
All outcomes
High riskAdverse events were not systematically ascertained

Selective reporting (reporting bias)Unclear riskInsufficient information to permit judgment of 'Yes' or 'No'.

Other biasUnclear riskStudy predates antiretroviral therapy. Patient immunologic and virologic markers not provided.

Veit 2009

MethodsA prospective double cohort study analysing a cohort of 102 patients infected with HIV given YF vaccination compared with serologic data from 209 patients not infected with HIV, also given YF vaccination.


Participants102 HIV-infected patients who reported a journey to a tropical destination from the Swiss Cohort study and 209 HIV-uninfected patients in Germany who were similar in age range to Swiss Cohort study. All participants received YF vaccination.


InterventionsArm 1: Patients infected with HIV receive YF vaccination (n=102)

Arm 2: Patients not infected with HIV receive YF vaccination (n=209)


OutcomesYF antibody response (immunogenicity and duration)


Notes4/102 HIV-infected patients showed nonreactive NTs at first analysis but developed reactive NTs during follow-up.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskObservational study

Allocation concealment (selection bias)High riskObservational study

Blinding of participants and personnel (performance bias)
All outcomes
High riskObservational study

Blinding of outcome assessment (detection bias)
All outcomes
High riskObservational study

Incomplete outcome data (attrition bias)
All outcomes
Low riskSimilar reasons for missing data across groups

Selective reporting (reporting bias)Unclear riskInsufficient information to permit judgment of 'Yes' or 'No'.

Other biasUnclear riskNone detected

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Camacho 2004Study population HIV-uninfected

Camacho 2007Study population HIV-uninfected

Goujon 1995Case series

Ho 2008Case series

Kengsakul 2002Case report

Monath 2002Study population HIV-uninfected

Osinusi 1990Study population HIV-uninfected

Pistone 2007Case series

Pistone 2010Case series

Receveur 2000Case reports

Ripoll 2008Study population HIV-uninfected

Roukens 2008Study population HIV-uninfected

Sidibe 2012Case series

Tattevin 2004Case series

Thomas 2012Review article

Veit 2010Review article

 
Comparison 1. Immunologic response to YF vaccine in HIV-infected children vs. immunologic response to YF vaccine in HIV-uninfected children

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Adequate antibody response (NT ≥1:10), follow-up median 29 months175Risk Ratio (M-H, Fixed, 95% CI)0.23 [0.08, 0.64]

 
Comparison 2. Immunologic response to YF vaccine in HIV-infected adults vs. immunologic response to YF vaccine in HIV-uninfected adults

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Immunogenicity: Adequate antibody response (NT ≥1:10), follow-up 1 yr1144Risk Ratio (M-H, Fixed, 95% CI)0.86 [0.77, 0.96]

 2 Duration: Adequate antibody response (NT ≥1:10), follow-up 1-10 yrs1162Risk Ratio (M-H, Fixed, 95% CI)0.88 [0.76, 1.02]

 
Comparison 3. Immunologic response to YF vaccine in HIV-infected adults before HIV diagnosis, vs. immunologic response to YF vaccine in HIV-infected adults after HIV diagnosis

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Immunogenicity: Adequate antibody response (NT ≥1:10), follow-up 1 yr1364Risk Ratio (M-H, Fixed, 95% CI)0.91 [0.85, 0.98]

 
Summary of findings for the main comparison. Immunologic response to YF vaccine in HIV-infected adults before HIV diagnosis, vs. immunologic response to YF vaccine in HIV-infected adults after HIV diagnosis

Immunologic response to YF vaccine in HIV-infected adults before HIV diagnosis, vs. immunologic response to YF vaccine in HIV-infected adults after HIV diagnosis

Patient or population: Adults with HIV infection
Settings: France
Intervention: YF vaccine in HIV-infected adults before HIV diagnosis, vs. YF vaccine in HIV-infected adults after HIV diagnosis

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of Participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

ControlYF vaccine in HIV-infected adults before HIV diagnosis, vs.YF vaccine in HIV-infected adults after HIV diagnosis

Immunogenicity: Adequate antibody response (NT ≥1:10), follow-up 1 yr962 per 1000876 per 1000
(818 to 943)
RR 0.91
(0.85 to 0.98)
364
(1 study)
⊕⊕⊝⊝
low

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 
Summary of findings 2. Immunologic response to YF vaccine in HIV-infected children vs. immunologic response to YF vaccine in HIV-uninfected children

Immunologic response to YF vaccine in HIV-infected children vs. immunologic response to YF vaccine in HIV-uninfected children

Patient or population: Children with HIV infection
Settings: Côte d’Ivoire
Intervention: YF vaccine in HIV-infected children vs.YF vaccine in HIV-uninfected children

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of Participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

ControlYF vaccine in HIV-infected children vs.YF vaccine in HIV-uninfected children

Adequate antibody response (NT ≥1:10), follow-up median 29 months737 per 1000169 per 1000
(59 to 472)
RR 0.23
(0.08 to 0.64)
75
(1 study)
⊕⊝⊝⊝
very low1,2

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 1 Pre-antiretroviral era.
2 Very few participants. Grade down by 2.
 
Summary of findings 3. Immunologic response to YF vaccine in HIV-infected adults vs. immunologic response to YF vaccine in HIV-uninfected adults

Immunologic response to YF vaccine in HIV-infected adults vs. immunologic response to YF vaccine in HIV-uninfected adults

Patient or population: Adults with HIV infection
Settings: Switzerland
Intervention: YF vaccine in HIV-infected adults vs.YF vaccine in HIV-uninfected adults

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of Participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

ControlYF vaccine in HIV-infected adults vs.YF vaccine in HIV-uninfected adults

Immunogenicity: Adequate antibody response (NT ≥1:10), follow-up 1 yr970 per 1000834 per 1000
(747 to 931)
RR 0.86
(0.77 to 0.96)
144
(1 study)
⊕⊝⊝⊝
very low1,2

Duration: Adequate antibody response (NT ≥1:10), follow-up 1-10 yrs880 per 1000775 per 1000
(669 to 898)
RR 0.88
(0.76 to 1.02)
162
(1 study)
⊕⊝⊝⊝
very low1,2

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 1 Retrospective analysis of a prospective cohort. Graded down by 1.
2 Very few participants. Graded down by 2.